Abstract
BackgroundThe aim of this study was to establish the prevalence of lipodystrophy and its association to cumulative exposure to antiretroviral drugs.MethodWe conducted a cross sectional study in all HIV- infected patients attending the HIV clinic in the Centre hospitalier universitaire de Montréal (CHUM) with DEXA scan. Lipodystrophy was defined as a trunk/limb fat ratio ≥ 1.5. Association between cumulative exposure to antiretroviral (measured in years of use) with trunk/limb fat ratio (coded as a continuous variable) was assessed using univariate and multivariate linear regression for each antiretroviral drug with at least 40 exposed patients.ResultsOne hundred sixty-six patients were included. Seventy-five percent were male, median age was 56 years, 67% were Caucasian. Overall, prevalence of lipodystrophy was 47%, with a mean trunk/limb fat ratio of 1.87, SD = 1.03, min = 0.6 and max = 5.87. Each 10-year increase in age and HIV infection duration was associated with an average increase of 0.24 and 0.34 for the trunk/limb fat ratio respectively. (p = 0.003, p = 0.002, respectively) Patients classified as lipodystrophic were more likely to be diabetic (50 vs. 28%, p = 0.07) and to have dyslipidemia (47 vs. 19%, p = 0.01). According to viral load at DEXA test, each one log increase was associated with less probability (0.7) of lipodystrophy. (p = 0.01) Among ARV drugs tested, there was an association between years of use of d4T, ritonavir and raltegravir and higher trunk/limb fat ratio (indicating more lipodystrophy) (p < 0.05).ConclusionLipodystrophy is very common in HIV infected patients and is correlated with duration of some new antiretroviral drugs.
Highlights
The aim of this study was to establish the prevalence of lipodystrophy and its association to cumulative exposure to antiretroviral drugs
Each 10-year increase in age and Human immunodeficiency virus (HIV) infection duration was associated with an average increase of 0.24 and 0.34 for the trunk/limb fat ratio respectively. (p = 0.003, p = 0.002, respectively) Patients classified as lipodystrophic were more likely to be diabetic (50 vs. 28%, p = 0.07) and to have dyslipidemia (47 vs. 19%, p = 0.01)
According to viral load at Dual energy X-ray absorptiometry (DEXA) test, each one log increase was associated with less probability (0.7) of lipodystrophy. (p = 0.01) Among ARV drugs tested, there was an association between years of use of d4T, ritonavir and raltegravir and higher trunk/limb fat ratio (p < 0.05)
Summary
The aim of this study was to establish the prevalence of lipodystrophy and its association to cumulative exposure to antiretroviral drugs. [7, 8] which usually occurs months to years after ARTs introduction and prevalence rates vary from 18 to 83% [8,9,10]. It is associated with hyperglycemia [11,12,13], hyperlipidemia [11], HIV infection and its duration [8, 14], level of immunity [15, 16], female gender [15], increasing age [9, 16] and type and duration of ARTs [16, 17]. Dual energy X-ray absorptiometry (DEXA) scan is a reliable method for definition of this syndrome [9]
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